Draft_Performance_Work_Statement_-_FBO.doc

Department of Homeland Security (DHS), U.S. Immigration and Customs Enforcement (ICE), Office of Human Capital (OHC)

Medical, Psychological, Fitness, and Drug Testing Services

Performance Work Statement (PWS)

January 19, 2017 Contents

3Part 1 - Overview and Contract Requirements

10Part 2 - Pre-Employment Medical Services

16Part 3 – Fitness for Duty / Independent Medical Examinations

22Part 4 - Drug Free Federal Workplace

30Part 5 - Deliverables

34Part 6 -Privacy & Records Office (PRO) Clauses

37Part 7 –Security Requirements

Performance Work Statement (PWS)

Medical, Psychological, Fitness, and Drug Testing Services

Part 1 - Overview and Contract Requirements

1.0 Introduction

The primary mission of the U.S. Department of Homeland Security (DHS) is to lead the unified national effort to secure the country and preserve our freedoms. While the Department was created to secure our country against those who seek to disrupt the American way of life, our charter also includes preparation for and response to all hazards and disasters. U.S. Immigration and Customs Enforcement (ICE) is responsible for the protection of the security of the American people and homeland by vigilantly enforcing the nation's immigration and customs laws.

1.1 Scope

This Performance Work Statement (PWS) encompasses Pre-Employment and Post Employment medical, psychological, fitness and drug testing services for ICE personnel. Pre-Employment medical services include applicant medical, fitness and drug testing in accordance with U.S. Department of Health and Human Services (HHS) regulations. Post Employment medical services include the following: support for the Drug Free Federal Workplace Program, Independent Medical Examinations and Ancillary Testing.

Potential deliveries of services include all 50 US states, plus locations in Puerto Rico, the Virgin Islands, and the Mariana Islands to include Guam.

Requests for the pre-employment testing of individuals from ICE will originate from the ICE Office of Human Capital (OHC) Dallas Pre-Employment Clearance (PEC) Unit and for ICE employee examinations and testing will originate from the ICE Office of Human Capital (OHC) Fitness for Duty Coordinator (FFDC) or Drug Program Coordinator (DPC).

1.2 Appendices.

The following is a list of all appendices for this PWS. The contractor shall implement the most current version as directives and regulations are updated.

a. 41 CFR Chapters 300-304, Federal Travel Regulations http://www.gsa.gov/portal/content/104790

b. HHS Mandatory Guidelines, https://www.samhsa.gov/workplace/drug-testing#HHS Mandatory Guidelines

c. HHS, Urine Specimen Collection Handbook For Federal Agency Workplace Drug Testing Programs (see Appendix A)

d. Public Law 104-191, Health Insurance Portability and Accountability Act of 1996 (HIPAA) - The Office for Civil Rights enforces the Health Insurance Portability and Accountability Act (August 21, 1996) Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety. The Contractor shall comply with the most recent version of HIPAA found at http://www.hhs.gov/hipaa

e. U.S. Department of Justice, Immigration and Naturalization Service, Medical Standards. (see Appendix B)

f. HHS, Medical Review Officer Manual for Federal Agency Workplace Drug Testing Programs. (see Appendix C)

g. U.S. Immigration and Customs Enforcement Drug-Free Workplace Plan (see Appendix D)

h. ICE Personnel – Duty Locations (see Appendix E)

i. ICE Deportation Officer Fitness Test Scoresheet “Draft” (see Appendix F)

j. SAMHSA list of certified laboratories (see Appendix G)

k. 5 CFR 399 Medical Qualifications (see Appendix H)

The Government will provide the following documents to the Contractor upon award:

l. Medical standards by position description

m. PEPR Practical exercise physical requirements.

n. Medical history form

1.3. Hours of Operation

The Contractor’s testing facilities and clinics should be open to the maximum extent practicable, so as not to hinder the ability of any applicant or employee to utilize the services provided under this contract.

In the event of a post-accident testing (see Part 5), testing facility and clinic availability should not be allowed to hinder the testing deadlines.

1.4. Geographic Locations

The examining medical/fitness/collection facilities must be located within the potential delivery destinations of all 50 US states, plus locations in Puerto Rico, the Virgin Islands, and the Mariana Islands to include Guam. The examining medical/fitness/collection facility selected should preferably be located within 50 miles of the employee’s home or work. In the event a facility is not located within 50 miles of the employee’s home or work the Government must be notified immediately.

1.5

PERSONNEL REQUIREMENTS

Medical Review Officer (MRO)

The HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs (Mandatory Guidelines) define an MRO as a licensed physician holding either a Doctor of Medicine (M.D.) or Doctor of Osteopathy (D.O.) degree who has:

• Knowledge regarding the pharmacology and toxicology of illicit drugs;

• Training in the collection procedures used to collect federal agency specimens; the interpretation of test results reported by laboratories; chain of custody, reporting, and recordkeeping requirements for federal agency specimens; the HHS Mandatory Guidelines for Federal Workplace Drug Testing Programs; and procedures for interpretation, review, and reporting of results as specified by the federal agency or agencies for which the individual may serve as MRO; and

• Satisfactorily passed an examination administered by an HHS-approved organization (i.e., a nationally recognized entity that certifies MROs or a subspecialty board for physicians performing a review of federal employee drug test results). HHS publishes an annual list of approved organizations in the Federal Register.

Reviewing Physician(s) must a licensed physician with documented experience in performing reviews of medical examinations in order to determine whether the applicant meets the Agency’s Medical Standards.

Program Manager (PM) must have at least five (5) years of managing programs of the same size, complexity, and scope of this Performance Work Statement. The Program Manager should be a Subject Matter Expert (SME) in the Medical Services Industry. The contractor shall provide a Program Manager that shall act as the central point of contact with the Government for all program-wide technical issues, and will represent the contractor at all post-award status meetings. The Program Manager shall be responsible for all issue resolution, program management, and other administrative support including providing comprehensive support for the contract. The Program Manager shall be a single point of contact for the IDIQ Contracting Officer and the IDIQ Contracting Officer’s Representative(s).

The Program Manager shall be available to the COR(s) via telephone between the hours of 8:00am-5:00pm (EST), Monday through Friday, and shall respond to a request for discussion or resolution of technical problems within twenty-four (24) hours of notification.

Contracts Administrator (CA) must have at least five (5) years of experience in government contracts and a working knowledge of the FAR. The Contract Administrator shall act as the central point of contact in all contract matters for the company. The Contract Administrator shall monitor company performance for conformance to original proposal and maintains continual review to ensure that all terms and conditions are in accordance with legal requirements, the Statement of Work specifications, and government regulations. The Contract Administrator prepares and disseminates information to the Program Manager regarding contract status, compliance, modifications, deviation, negotiation, etc. The Contract Administrator and the Program Manager shall participate in post award kick-off meetings and contract set-up meetings.

1.6. Contractor’s Responsibilities

1. The contractor’s responsibilities shall include, but not limited to, providing all labor, materials, and equipment necessary for the applicant/employee medical examination services, fitness assessments, and for the collection and transportation of all specimens.

2. The contractor shall pay all fees and postage relating to information submitted to the Government, including forms, reports, shipping to collectors, etc.

3. For Random Drug Testing, the contractor shall identify and establish facilities for examination services and for specimen collection and ensure that they are equipped with appropriate supplies and materials within seven (7) calendar days of the Government’s request. Should the contractor have problems or issues with a particular subcontractor or facility, the primary contractor shall notify the Government via the appropriate designated contracting officer’s representative (COR), within 48 hours and shall note any corrective action undertaken.

4. The contractor shall reschedule, within 48 hours, all applicants/employees whose specimens have been rejected or lost and shall not bill the Government for any specimens that are rejected or lost due to collection errors.

5. For Independent Medical Examination, the contractor shall invoice the Government only after all of the agency’s questions have been fully answered.

1.7. Contractor Quality Control Plan

The contractor is responsible for the quality and timeliness of all services and products under this PWS. The contractor shall monitor pending exams/tests and follow up with facilities to ensure the completion of services are within required timeframes stated in this PWS.

1.8 Electronic Files

The contractor shall send the Government electronic files containing information on their medical, fitness testing, and drug testing scheduling activity that took place within the previous 24 hours on a daily basis. The file shall be sorted by the type of test. The file shall specify applicants who were difficult to reach or failed to keep the appointment. Difficult to reach applicants are those whom the contractor has been unable to reach after three documented attempts. The contractor is expected to attempt to reach the applicant on at least three different occasions and to document the details of each attempt. These calls are expected to be made at different times of day using all phone numbers available.

1.9 Contractor’s Data and Reporting Requirements

The Government requires the contractor to have a web-based protected site, in compliance with the Privacy Act at 5 U.S.C. 552a, which enables the user to determine the current status of a requested examination at any time and shows the scheduling dates for the examination(s) and estimated date for the return of results. The contractor must provide the Government users with the ability to produce standard and ad hoc reports from the data system. If the established reports are not responsive to the Government user, the contractor must provide the requested reports within five calendar days of the request.

1.10 Security Procedures

The Government reserves the right to require a full-field background investigation of any contractor employee assigned to perform services. The contractor is responsible for ensuring that all information and medical records obtained are maintained in a strictly confidential manner. The records must be stored either in locked, fireproof metal filing cabinets or in a secured room that is not accessible to the general public or visitors.

1.11 Release of Information

All records are subject to the Privacy Act, 5 U.S.C. 552a. The information and records shall be maintained and used with the highest regard for applicant/employee privacy. Applicants/employees may review the information obtained from the physical/medical exam. However, they shall not be allowed to have unsupervised access to their medical records. Individuals may obtain a copy of their medical examination results by sending an original notarized letter authorizing release of the information, to which the information is to be released, along with the address of where the information is to be mailed.

For requests concerning pre-employment examinations, the Release of Information Authorization and request should be addressed to

Entry Level Hiring Unit

OHC Dallas

Immigration and Customs Enforcement (ICE)

7701 N. Stemmons Freeway, 6th Floor

Dallas, TX 75247

For requests concerning Fitness for Duty examinations, the Release of Information Authorization and request should be addressed to

Medical Officer

Office of Human Capital

U.S. Immigration and Customs Enforcement

500 12th

Washington, D.C. 20020

1.12 Billing

Invoice submission shall be monthly via email to ICE Finance Center (invoice.consolidation@ice.dhs.gov), COR and ACOR.

Invoice cover sheet shall include the following (pdf format):

· Contractor Business Name

· Contract/Task Order;

· Invoice Number;

· Bill To;

· Remit To;

· Billing Period;

· Amount Billied;

· Current Amount;

· Cumulative Amount;

· Invoice Total;

· EFT Information (bank name, ABA and account name/number);

· DUNS Number;

· Contractor POC information;

Invoice detail spreadsheet shall include the following (xls format):

· Contractor Business Name;

· Contract/Task Order;

· Invoice Number;

· Patient information (per exam) - (invoice date, facility , patient name, last 4 of SSN, exam date, appointment date, category, exam type, exam procedure/exam name, price billed, invoice total;

1.13 Additional Services

In the event the medical requirements change, within either ICE’s Pre-Employment, Post-Employment or Drug Free Work force program, the Government may negotiate additional CLINs added to this IDIQ. These additional services must fall within the scope of Medical, Psychological, Fitness, and Drug Testing Services as stated in Paragraph 1.1.

1.14 Ancillary Support

Other ancillary support, integral and necessary as part of a total integrated solution within the scope of Medical, Psychological, Fitness, and Drug Testing Services, for which there is not a labor category specified or includes other direct costs such as travel, materials, equipment, venues, Subcontractors, etc., to obtain a total solution, are allowable costs and may be included within an individual task order under this Medical, Psychological, Fitness, and Drug Testing Services IDIQ.

An example would be a Mobile One Stop Hiring event. In the event the Government requires this service, the costs will be negotiated at the time the service is requested.

Part 2 - Pre-Employment Medical Services

2.0 Description

Federal agencies are responsible for ensuring that their employees are fully qualified to safely and efficiently perform the essential duties of their respective positions. In law enforcement and other safety sensitive areas, this mandate takes on extraordinary significance in that certain positions require the employee to engage in activities that are strenuous, hazardous, and carry a high degree of responsibility to the public. These areas are generally, but not exclusively, weapon carrying positions. Because of this and in accordance with 5 CFR 339, Federal agencies have the authority to require:

1. that applicants undergo a pre-employment medical examination and provide specific documentation related to their medical histories; and

2. that employees demonstrate their continued medical suitability for the position based on previously established medical guidelines, physical requirements, and critical tasks specific to each position.

Federal agencies are also authorized to perform drug testing and fitness test (for certain designated positions)

Psychological screening should be treated as a component of the Pre-Employment medical examination. Any Pre-employment psychological consultation would be a paper records review only. If requested as part of a Fitness for Duty exam (FFDE) it would require a specialty consultation with a psychologist or psychiatrist.

When requested as part of a FFDE the request will describe the services requested. During the Pre-Employment Examination any tool commonly employed in a primary care setting is appropriate. A “virtual face-to-face” is not specific and would not be appropriate for either a Pre-Employment or FFDE.

2.1.

Pre-Employment Drug Screening

All Pre-Employment Drug Test Collection will occur at a clinic within the 50 mile limit from the applicant’s recorded address and be performed in accordance with HHS guidelines.

1. Drug Screening Process/ Scheduling

On a daily basis, or as needed, ICE OHC Pre-Employment Clearance (PEC) Unit will send an electronic file to the contractor to notify them of the applicants’ drug screening requests. This notification will be an electronic web-based data file. This file will contain all the contact information about the applicants’ test scheduling.

Within three (3) working days of the initial notification, the contractor shall be responsible for coordinating the scheduling of the services with the applicant. Upon successfully notifying the applicant of the need for a urine specimen, the contractor shall make provisions to assure that the applicant provides such a specimen within 48 hours of the applicant being notified. The Medical Reviewing Officer will notify OHC Dallas PEC Unit within two (2) working days after notification of the results of the test. It is the responsibility of the Medical Review Officer to report positive and irregular results to OHC Dallas PEC Unit as they are identified.

The contractor shall make three (3) attempts to contact the applicant, via telephone, to notify the examinee for the appointment date, time, address, and contact person.

2. Procedure in the Event of Applicant unavailability, “no shows”, no nearby clinic

In the event the applicant is unable to schedule within 48 hours the contractual medical company must refer the examination request back to the initiating OHC Dallas PEC Unit.

If an applicant does not appear for the scheduled examination, the contractor shall notify OHC Dallas PEC Unit immediately (within 4 hours of the scheduled appointment). “No shows” fees will not be billed to the Government. The Government reserves the right to cancel or reschedule prior to 24 hours of the scheduled appointment without any fee.

In certain cases, the contractor may be required to travel to the individual’s location if the collection site is not located within 50 miles of the applicant. This will be at no cost to the Government.

2.2. Pre-Employment Physical Fitness Tests (PFT)

1. General Information

Before commencing the PFT, applicants may have completed the pre-employment medical examination, including blood pressure readings and a twelve-point EKG with Medical Doctor’s Interpretation. At times, applicants may be required to complete a combination of required services: EKG, Fitness/Performance assessment, and Drug Test.

In the event that no contraindications to participation have been identified, and the applicant provides signed consent to be tested, then the fitness assessments may be administered. It should be noted that testing is always stopped at the request of the applicant for chest pain or other problems, or if the test administrator determines that testing should be stopped.

2. Description of Physical Fitness Test

This PFT, for ICE applicants only, consists of three parts and allows for a three-minute rest period between each part. The following describes the components:

a. Kneel/Stand Test

The test consists of 10 changes of position, an extended period of upright kneeling (2 minutes), followed by the final position change. The test is administered as one continuing test, with two parts, which are timed separately. The initial ten changes must be completed within 25 seconds and are immediately followed by two minutes of kneeling and then coming to a full standing position. Both parts of the test require the maintenance of upright postures with minimal posture deviations especially during change of positions. The applicant will be required to hold both arms extended in front as if holding a firearm. An audiotape will provide verbal cues during this test so that applicant does not have to memorize the sequence.

b. Push-up Test

This is a timed test requiring completion of fifteen proper form push-ups in two minutes. The depth of the push-up will be measured using a foam block. Rests between push-ups, if needed, must be taken in the “up position.” The test administrator will evaluate the applicant’s form during the test and will provide instructions as to when to start and stop.

c. Step Test

This is a timed test requiring that the applicant step up and down on a 16 inch high step at a rate of 96 steps per minute for a total of 5 minutes duration. An audiotape, containing constant beat and verbal cues shall be used. The audiotape also contains special instructions to switch the lead leg every minute to avoid local muscle fatigue. The audiotape is responsibility of the contractor.

These tests are to be administered per the protocol outlined in the following link:

https://www.ice.gov/careers/occupations#wcm-survey-target-id Go to - > Occupations - > Enforcement and Removal Operations - > DRO Applicant Physical Fitness Test (video and script) and Pre-Employment Fitness (PDF)

The ICE Administrator Score Sheet must be utilized for each Fitness Test.

3. Procedures in the Event of Applicant Inability to Successfully Complete the PFT

In the event that an applicant fails to successfully complete any one component of the PFT, the test administrator conducting the assessment will stop the test at the point (component) the applicants fails to successfully complete and must fully describe, in a type written format, the specifics of the event and reason for failure or for stopping the assessment on the back of the assessment score sheet. The test administrator shall legibly sign and date the document, notify the contractor of the failure within one (1) working day and forward all materials, documentation, score sheets, etc. to OHC Dallas PEC Unit within one (1) working day of the test. In the event that the test must be stopped because of the applicant’s inability to successfully complete a component or if the applicant becomes symptomatic and the test administrator stops the test, the contractor will bill and be paid for the entire test.

2.3. Pre-employment Medical Examinations

When contacting the applicant to schedule a medical exam and fitness assessment, the contractor shall advise the applicant that medical records related to current or past medical conditions should be copied and brought by the applicant to the medical examination., This includes any Veterans Affairs Disability Rating Decision letters and any form of disability compensation that the applicant may be receiving. The applicant should be made aware that the individual is expected to provide these records to the examining physician.

1. Pre-Employment Medical Examination Process

Medical examinations performed under the auspices of the PWS must be consistent with established medical guidelines for weapon-carrying positions. Specifically, the medical screening must include a thorough assessment of the applicant’s medical history and must determine the following:

a. The applicant’s current and forecasted future medical suitability for fulfilling the duties of the advertised positions;

b. Whether the individual has a history of a particular medical problem in which recurrence cannot be medically ruled out;

c. The etiology of any disease or condition;

d. The level/degree of stability of an existing or past disease/condition;

e. The level/degree of severity of conditions identified, and

f. The existence and extent of any current concern that is not identified in history, but which may be present during the exam.

Forms to be used in the recording of the medical history and examination’s physical findings have been developed by the Government and will be utilized for examination purposes. These forms also serve as guidelines as to what information is salient to the exam process and include guidelines for the measurement of:

a. vital signs

b. height/weight

c. vision

i. corrected and uncorrected visual acuity (near and distant)

ii. peripheral vision

iii. visual depth perception

iv. Hardy, Rand and Rittler (HRR) pseudo isochromatic plate test for color vision testing

d. pure tone audiometry (500; 1,000; 2,000; 3,000; 4,000; 6,000; 8,000 frequencies)

e. tuberculosis skin test results (to be read 48 to 72 hours past administration)

f. Chest x-ray for all applicants who have a positive tuberculosis skin test

g. medical doctor’s interpretation of twelve lead EKG (upon review of the EKG, the Reviewing Physician must sign or otherwise initial the EKG) and interpretation of the chest x-ray when the applicant has a positive tuberculosis skin test

2. Scheduling

The contractor shall have three (3) working days from OHC Dallas PEC Unit notification to contact applicants to schedule medical tests (and PFTs, if applicable). Upon successfully notifying the applicant of the need for medical and/or fitness test, the applicant is given five (5) working days to complete the pre-employment medical screening and PFT process (if applicable). The Reviewing Physician shall review the completed examination to determine if an applicant is medically suitable for the position. The Reviewing Physician shall render a type written medical opinion to the OHC Dallas PEC Unit within seven (7) working days of the pre-employment medical exam date.

If an applicant does not appear for the scheduled examination, the contractor shall notify OHC Dallas PEC Unit immediately (within 4 hours of the scheduled appointment). “No shows” fees will not be billed to the Government. OHC Dallas PEC Unit reserves the right to cancel or reschedule prior to 24 hours of the scheduled appointment without any fee.

The contractor shall make three (3) attempts to contact the applicant, via telephone, to notify the examinee for the appointment date, time, address, and contact person.

2.4 Medical Conclusion/Recommendation Process for Pre-Employment Medical Services

After performing an assessment of the applicant’s medical history and a comprehensive systematic examination, the examining physician shall complete a summary of the findings in order to establish the applicant’s health status and the stability of the condition(s) identified.

The examining physician shall refrain from making any recommendation verbally or in writing to the individual regarding the individual’s medical suitability for the position. Rather, the examining physician shall forward the exam/history data to the Reviewing Physicians.

The Reviewing Physicians shall possess an understanding of the stressors and responsibilities of the various positions and shall be thoroughly knowledgeable of the medically established guidelines for each position. Occupations may be added or guidelines may be revised as needed by the Government, and the contractor shall adjust work processes and occupational knowledge as needed. Upon review of the information obtained from the applicant pre-employment medical examination, the Reviewing Physicians shall determine whether the individual meets the medical requirements of the position. The OHC Dallas PEC Unit staff will receive and review the Reviewing Physician’s recommendation, and forward to management accordingly.

1. Reviewing Physicians shall be responsible for:

a. Reviewing all medical history and examination records and ensuring their completeness.

b. Ensuring that the information obtained from the medical examination, the medical findings, conclusions, and recommendations are consistent with generally accepted professional guidelines.

c. Ensuring that the examination procedures and methods for reporting the information are uniform.

d. Indicating to the OHC Dallas PEC Unit staff through a type written report seven (7) working days of receipt of a file whether and what additional medical documentation is necessary to clarify the status of a particular medical condition(s).

e. Providing an opinion as to the applicant’s medical suitability for the position including a description of current health status, stability of condition, and the rationale for the decision. This recommendation shall be type written in narrative form and shall indicate exactly what documentation was reviewed prior to reaching the decision. The type written medical opinion of the applicant’s suitability for the position shall be submitted within seven (7) working days from receipt of medical records. If the results of the medical exam do not clearly support the applicant’s suitability for the position, the Reviewing Physician’s opinion shall specify what additional medical documentation is needed to clarify the status of a particular medical condition(s).

f. Providing a letter to send to the applicant that states that they have 30 days to respond.

2. Timeframes:

The Reviewing Physician shall provide a type written medical opinion of the applicant’s suitability for the government position to ICE within seven (7) working days of the completion of the medical examination, a Primary Review. If the review of the medical examination does not clearly support the applicant’s suitability for the position, the Reviewing Physician’s opinion shall specify what additional medical documentation is needed. The Reviewing Physician may be requested to perform a review of the additional medical documentation received and provide an opinion on suitability, a Secondary Review. A type written medical opinion based on the Secondary Review shall be provided to the Government within nine (9) working days beginning from the date upon which the OHC Dallas PEC Unit or OHC Medical Branch or their designee receives the additional medical documentation and determines that a Secondary Review is required.

Part 3 – Fitness for Duty / Independent Medical Examinations

3.0. Description

Medical examinations performed under the auspices of the PWS must be consistent with the medical guidelines for weapon-carrying positions. Specifically, the medical examination shall include an assessment of the individual’s medical history and his or her current medical and physical status and provide sufficient information to provide a recommendation concerning the individual’s continued suitability for the position. There are different scopes of the different types of medical examinations to include a General Medical Examination when there is a question of the presence of a mental health condition or there are multiple ill-defined medical concerns. The next level is Specialty Consultant Medical Examination where a physician specializing in the area of medicine concurrent with the employee’s medical condition will perform the medical examination. In complex cases or where there is dispute regarding the employee’s medical condition and its impact on safely and effectively performing the duties of the job, a Certified Independent Medical Examination will be required for all physical diagnoses with a Forensic Psychiatric Examination required for mental health diagnoses.

Expert opinion would involve case review, a narrative summary and in some case in-person testimony.

3.1 General Medical Examination Process.

The government will have obtained the necessary authorization for release of medical documentation forms prior to requesting a Fitness-for-Duty Examination FFDE . Once the contractor has received copies of past medical treatment records for treatment of the medical condition creating a concern about the employee’s ability to safely and effectively do their job, the contractor will schedule an appointment for the specific type of medical examination specified by the government. .

A. General Medical Independent Medical Examination

For medical examinations where the specific diagnosis or therapy are unknown, or in an effort to determine if there is any medical or physical condition that would explain the employee’s performance or conduct problems, a general medical independent medical examination is conducted. This type of examination may also be used to determine fitness for special assignments to high-risk tactical units. Once the contractor has received the request for the examination and the signed authorization for release of medical documents, the contractor will request and obtain copies of the documents specified in the authorization forms. Once received, the contractor shall schedule an appointment for an FFDE within 5 working days of. The examination shall take place within thirty (30) working days of being scheduled. The examination shall be within 50 miles of the employee’s home or workplace. For FFD exams where an employee requires a unique specialty provider or where the employee is in a remote location, the contractor may be allowed to schedule appointments outside the 50 mile radius and 30 day completion time. The contractor will notify the requesting FFD Coordinator office of the unique circumstances so a mutually agreeable appointment date, time, and location can be established. The contractor shall provide the Government with the specifics of the appointment within 48 hours of being scheduled, to allow the Government sufficient time to notify the employee. It should be noted that in all FFDEs it is the Government and not the contractor who is responsible for informing the employee of the appointment and for having the employee sign all necessary forms for the examination. The Government will provide the contractor with all necessary signed forms at the time the FFDE is requested.

The contractor’s Primary Reviewing Physicians shall review all exam and lab results, and provide a final report to the ICE Fitness for Duty Coordinator office within five (5) working days from receipt of results. In the event that the Contractor’s Primary Reviewing Physicians indicate that a more detailed assessment by a physician specialist is required, the Primary Reviewing Physicians shall notify the ICE Fitness for Duty Coordinator staff within five (5) working days from receipt of results and upon the coordinator’s approval will then schedule the appropriate specialist examination.

If an employee does not appear for the scheduled examination, the contractor shall notify the ICE Fitness For Duty Coordinator (FFDC) immediately (within 4 hours of the scheduled appointment) and the Government will reimburse the contractor a fee, not more than one-half the billing amount for that CLN that was requested by the government. The Government reserves the right to cancel or reschedule prior to 24 hours of the scheduled appointment without any fee.

B. Specialty Consultant Independent Medical Examinations

The Government will request a Specialty Consultant Independent Medical Examination whenever there is a question regarding the employee’s fitness for duty, which requires the training and experience of a particular type of specialty consultant, such as: Orthopedics, Internal Medicine, Cardiology, Neurology, Ophthalmology, general Psychiatry (Psychological), Functional Capacity Evaluation by a Physical Therapist, etc. Fitness for Duty Medical Examinations includes scheduling fees, ancillary tests listed in above. This level of service Specialty Consultation will be requested by the Government when there are general questions concerning an employee’s injury or fitness for duty as noted on the ICE Fitness for Duty Request which may include:

· What, if any, additional medical records were reviewed in conjunction with this evaluation?

· In your opinion, what is the employee’s diagnosis, the severity of the condition at present, and the prognosis for the condition? Please provide a detailed explanation for every opinion you provide.

· In your opinion, can the employee safely and efficiently perform all of the essential duties of the position? As to any essential duty the employee is unable to safely and efficiently perform, please provide a detailed explanation of the bases for your opinion(s).

· What, if any, restrictions or limitations does the employee currently have with respect to performing the essential duties of the position? As to each restriction or limitation, please provide a detailed explanation about the severity and the nature of the restriction or limitation.

· If the employee is presently able to perform the essential functions of the position, can a recurrence of any past medical condition be ruled out? If a recurrence cannot be ruled out, please state with a reasonable degree of medical certainty whether a recurrence would pose a reasonable probability of substantial harm to the employee or others given the nature of the duties to be performed. Please provide a detailed explanation to support the bases of your opinion(s).

· What, if any, medications does the employee currently take or has taken within the last six months that may affect the employee’s ability to perform the essential duties of the position? If any medication would have this affect, please provide a detailed explanation to support your opinion.

· If the employee requests a copy of your report, may the report be issued to the employee directly or do you recommend that your report be issued to a physician/treatment professional of the employee’s choice?

Fitness for Duty Specialty Consultant Medical Examinations covered in this PWS will be specified by the ICE FFDC and will include all of the following: scheduling of the applicant for applicant medical screening, all nursing support, ancillary tests as necessary and a comprehensive report which addresses the questions posed, along with the provision of a fitness for duty recommendation.

Any Fitness for Duty recommendation must reflect the employee’s fitness status as of the date of the evaluation without future recommendations, based upon comparison with the employee’s position description.

If a general Psychiatry (Psychological) Specialty Consultant examination for a FFDE is necessary it will be specifically requested by the FFDC and a general medical FFDE will be performed prior to the psychological specialty consultant evaluation to determine if there is a non-psychiatric explanation for the employee’s performance or conduct problems. For psychological FFD examinations, the FFDE will always request a general medical examination prior to the psychological examination. Appropriate psychiatric/psychological testing should accompany all general Psychiatry (Psychological) Specialty Consultant examinations, inclusive of Minnesota Multiphasic Personality Inventory (MMPI-2) testing and evaluation.

C. Certified Independent Medical Evaluation

The Government will request a Certified Independent Medical Evaluation (CIME) whenever there is a question requiring the training and experience of a certified Independent Medical Examiner (CIME) or certified Forensic Psychiatrist with specific credentials and experience. The Government will request this level of highly skilled evaluation when there is conflicting or contradictory medical documentation which the ICE FFDC notes cannot be resolved through the use of a lower level of service Specialty Consultant. Fitness for Duty Independent Medical Evaluations include: scheduling of the employee for the evaluation and all nursing support. Due to the requirement for a highly skilled, trained, and experienced provider the contractor may, only upon agreement with the ICE Fitness for Duty Coordinator be allowed to schedule appointments outside the 50 mile radius and 30 day completion time. The contractor will notify the requesting FFDC Office prior to scheduling the appointment of the unique circumstance in order to schedule a mutually agreeable appointment date, time, and location. A Specialty CIME Consultation will be requested by the Government when there are more specific questions, in addition to those posed for a Specialty Consultant concerning an employee’s injury or fitness for duty as noted on the ICE Fitness for Duty Request which may include;

· What, if any, additional medical records were reviewed in conjunction with this evaluation?

· In your opinion, what is the employee’s diagnosis, the severity of the condition at present, and the prognosis for the condition? Please provide a detailed explanation for every opinion you provide.

· In your opinion, can the employee safely and efficiently perform all of the essential duties of the position? As to any essential duty the employee is unable to safely and efficiently perform, please provide a detailed explanation of the bases for your opinion(s).

· What, if any, restrictions or limitations does the employee currently have with respect to performing the essential duties of the position? As to each restriction or limitation, please provide a detailed explanation about the severity and the nature of the restriction or limitation.

· If the employee is presently able to perform the essential functions of the position, can a recurrence of any past medical condition be ruled out? If a recurrence cannot be ruled out, please state with a reasonable degree of medical certainty whether a recurrence would pose a reasonable probability of substantial harm to the employee or others given the nature of the duties to be performed. Please provide a detailed explanation to support the bases of your opinion(s).

· What, if any, medications does the employee currently take or has taken within the last six months that may affect the employee’s ability to perform the essential duties of the position? If any medication would have this affect, please provide a detailed explanation to support your opinion.

· If the employee requests a copy of your report, may the report be issued to the employee directly or do you recommend that your report be issued to a physician/treatment professional of the employee’s choice?

but will also include the specific additional questions annotated by the FFDC on the ICE Fitness for Duty Request and, if necessary included on a supplemental letter to the CIME.

Independent Medical Evaluations covered in this PWS will be specifically requested by the FFDC and will include all of the following: scheduling of the employee for evaluation, all nursing support and a comprehensive report which addresses all questions posed, along with the provision of a fitness for duty recommendation.

Any Fitness for Duty recommendation must reflect the employee’s fitness status as of the date of the evaluation without future recommendations, based upon comparison with the employee’s position description.

There may be a situation in which a follow-up evaluation is necessary by a IME to clarify an issue or to evaluate ongoing treatment. As this follow-up evaluation does not require the extensive review of the past records and the purpose is to clarify an issue or review an ongoing treatment, the follow-up examination billing would revert to a Specialty Consultation versus a new IME Consultation for billing purposes.

D. Forensic Psychiatric Evaluation

The Government will request an Independent Medical Evaluation whenever there is a question requiring the training and experience of a certified Forensic Psychiatrist. A psychologist is not acceptable for this level of service request. The Government will request this level of highly skilled evaluation when there is conflicting or contradictory medical documentation which cannot be resolved through the use of a Specialty Consultant general Psychiatrist.. The Government Fitness for Duty Coordinator will specifically request this level of an evaluation when necessary.

Independent Medical Evaluations requiring a certified Forensic Psychiatrist covered in this PWS will be specifically requested by the FFDC and will include all of the following: scheduling of the employee for examination, all nursing support and a comprehensive report which addresses all questions posed, along with the provision of a fitness for duty recommendation.

Any Fitness for Duty recommendation must reflect the employee’s fitness status as of the date of the evaluation without future recommendations, based upon comparison with the employee’s position description.

If an Independent Medical Evaluation for psychological evaluation requiring a certified Forensic Psychiatrist for a FFDE is necessary, it will be specifically requested and a general medical FFDE will be performed prior to the certified Forensic Psychiatric evaluation. For psychological FFD examinations, the FFDE will always request a general medical examination prior to the psychological examination.

3.2. Ancillary Medical Tests

A Fitness for Duty Examiner may need an ancillary test to make a recommendation regarding an employee’s ability to perform the duties of their position description as noted in the above paragraphs. These tests must be either specifically requested by the government or specifically approved.

· OSHA Audiometry

· Blood glucose

· Blood lead level

· CBC with differential

· Chemistry Profile

· Cardiac risk level (The Cardiac Risk Profile is a very standard phrase referring to a laboratory determination of serum total cholesterol, triglycerides, LDL, HDL, and a ratio estimating a person risk for developing cardiovascular disease.)

· Color vision assessment (Ishihara 14 plate edition)

· Hemoglobin A1C

· Lab profile (CBC with differential, chemistry profile, urinalysis)

· Maximal stress EKG with MD interpretation

· Peripheral vision and visual depth perception

· Protoporphyrin, zinc (ZPP) blood test

· Resting twelve lead EKG with MD interpretation

· Spirometry (FVC%, FEV1, FEV1/FVC%)

· Thyroid Panel

· TB Skin test (with chest x-ray if indicated)

· Urinalysis

· Visual acuity (corrected and uncorrected, near and distant)

· Psychological/Psychiatric testing

· Resting EKG with physician interpretation

· Chest x-ray with physician interpretation for those with a positive tuberculosis skin test and symptoms suggestive of pulmonary tuberculosis.

3.3 Pre-employment Medical Tertiary review consultations

There may be occasions when the Agency Medical Officer is not available to complete a tertiary review. The tertiary review is required when upon review of the requested additional medical information, a secondary review, does not support that the applicant is qualified under the Agency’s Medical Standards. The secondary review is normally performed by a qualified nurse in the ICE Office of Human Capital. These secondary and tertiary reviews consist of a review of the initial pre-employment medical examination and any documents submitted by the applicant in response to a notification of the need for such documentation defined by the primary reviewer, performed by the contract reviewing physician. Upon request by the COR, the tertiary review consultation would consist of the consultant reviewing the entire pre-employment medical history, physical examination and any other documentation provided by the applicant with the final product being a legally defensible medical opinion explaining which medical documents were reviewed, whether the applicant meets the medical standards, and any additional supporting documentation that may support the Agency granting a waiver of the disqualifying medical condition. The report will note the specific disqualifying medical conditions, and the type of additional medical documentation, if any, is noted as well as recommendation for evidence regarding past demonstrated performance of the same or similar duties, providing specific, detailed examples.

Part 4 - Drug Free Federal Workplace

4.0 Background

The primary objective of a urine drug screening program is to establish and maintain a Drug Free Federal Workplace in accordance with Executive Order 12564 and Public Law 100-71. The work shall be performed in accordance with all applicable policies procedures and rules set for the by HHS rules outlined in the “Urine Specimen Collection Handbook for Federal Workplace Drug Testing Programs” at http://workplace.samhsa.gov/DrugTesting/SpecimenCollection/UrnSpcmnHndbk10012004.htm. The contractor shall update processes, as necessary, according to the HHS rules outlined in the above referenced handbook, and stay abreast of HHS requirement changes, and modify processes to accommodate HHS requirement modifications.

The contractor shall, upon notification from ICE authorized officials, select from the Designated Drug Testing Position List an adequate number of random donors and coordinate this random selection list with the DPC who will determine which donor will have an on-site (at ICE location) or off-site (at contractor clinic location) collection and coordinate this determination with the contractor who will collect urine specimens from applicants/employees listed for off-site collection. The Government will send electronic files to the contractor to maintain the Designated Testing List. The collections may occur at many duty locations and the contractor shall be willing to make these collections by establishing a clinic if necessary. The contractor shall also make available a Litigation Package consisting of the necessary documentation (the litigation packet contains the collection form, the results of the immunoassay test, the results of the GCMS tests, the MRO’s review, the lab equipment calibration materials and the protocols for how the testing is conducted) from the HHD-certified laboratory and expert witnesses, as necessary, in connection with administrative and judicial proceedings.

Under the Random Drug Test Program, collections will be made at government facilities where large numbers of employees are assigned. The number of government facility collection sites and collections will be small and arranged with the DPC.